Understanding Calcium: Supplements, Calcium Carbonate, Calcium Citrate, and More

Experts share their advice about what to consider when choosing a calcium supplement.

Are you getting enough calcium in your diet? Maybe not, especially if you're a woman or a teenage girl. Although Americans have improved at this in recent years, we're still not getting enough calcium to maintain our bone health.

How much is that? It depends on your age. According to the Institute of Medicine, the recommended daily amount of calcium to get is:

1-3 years: 700 milligrams daily4-8 years: 1,000 milligrams daily9-18 years: 1,300 milligrams daily19-50 years: 1,000 milligrams daily51-70 years: 1,200 milligrams daily for women; 1,000 milligrams daily for men71 and older: 1,200 milligrams daily

The Institute of Medicine says that most in the U.S. get enough calcium, except for girls 9 to 18 years old. Although women’s recommended calcium needs to increase with menopause, postmenopausal woman taking supplements may also be at greater risk of getting too much calcium.

"We know that peak bone mass occurs around age 30, so it's very important in childhood and adolescence to have a healthy intake of calcium early on," says Marcy B. Bolster, MD. She is a professor of medicine in the division of rheumatology and immunology at the Medical University of South Carolina and director of the MUSC Center for Osteoporosis and Bone Health.

"After age 30, we start to gradually lose bone, and that loss accelerates for women at the time of menopause. So it's very important to stave off bone loss with adequate calcium intake."

Your health care provider may recommend calcium supplements. But with so many choices of calcium supplements, where should you start? Here's what you need to know.

"I tell my patients to take the kind that they tolerate best and is least expensive," Bolster says. She says she recommends calcium carbonate because "it's inexpensive, won't cause discomfort, and is a good source of calcium."

Some people's bodies may have problems making enough stomach acid, or may be taking medications that suppress acid production. For them, says J. Edward Puzas, MD, a calcium citrate supplement might be better because it "dissolves a little better than calcium carbonate for these people." Puzas is a professor of orthopedics and director of orthopedic research at the University of Rochester Medical Center in New York.

What about other types of supplements, like calcium plus magnesium, coral calcium, and so on? Not necessary, the experts tell WebMD. But they note that supplements that combine calcium with vitamin D -- which is essential for the body to appropriately absorb calcium -- provide an added benefit.

The body can absorb only about 500 milligrams of a calcium supplement at any one time, says Puzas, so you can't just down a 1000-mg supplement first thing in the morning and call it a day.

Instead, split your dose into two or three servings a day. "The best way to take it is with a meal; calcium is absorbed better that way," Puzas says. If your daily diet includes calcium-containing foods and drinks, you may not need multiple doses.

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Women on HRT Helped by Extra Calcium, Vitamin D?

Study found hip fracture rate was 57 percent lower in those also taking supplements

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 26 (HealthDay News) -- Although there has been significant debate about whether calcium and vitamin D supplements are beneficial for older women, new research suggests that the answer may be yes for those who are taking hormone replacement therapy.

Women using HRT who also took daily supplements of calcium and vitamin D saw a 40 percent reduction in their rate of hip fractures compared to women who took placebo supplements, according to the study.

"We found that women who were on hormones had less hip fractures, and women who were on hormones and calcium and vitamin D supplements had even fewer hip fractures," said study author Dr. John Robbins, a professor of medicine at the University of California at Davis.

Results of the study were published online June 26 in the journal Menopause.

As many as half of all women over 50 will have an osteoporosis-related fracture in their lifetime, according to the U.S. Preventive Services Task Force (USPSTF). Osteoporosis is a condition caused by a loss of bone mass and density, which leaves bones fragile and more susceptible to fractures. Calcium is an important component in bone growth, and vitamin D helps the body absorb calcium.

What's not clear is if supplements of these nutrients are as helpful in keeping bones strong as they are from natural sources, such as diet. The USPSTF recently looked at the effect of 1,000 milligrams of daily calcium and 400 international units of vitamin D. In February, they concluded that women shouldn't take calcium and vitamin D supplements because the available evidence wasn't strong enough to show a significant benefit. They added that the benefits of higher doses are unknown.

The new study included data from the Women's Health Study on about 30,000 postmenopausal women between the ages of 50 and 79. Many of the women were taking hormone replacement therapy -- either estrogen alone or a combination of estrogen and progesterone.

Just over 16,000 women participated in the calcium and vitamin D portion of the study. They were randomly selected to receive either a placebo or 1,000 milligrams of calcium and 400 international units of vitamin D each day. The average follow-up time was about seven years.

The hormone therapy and the supplements together were the most effective treatment for reducing hip fracture risk. The researchers found that the combination reduced the risk of hip fracture by 57 percent.

Overall, the rate of hip fracture was 11 per 10,000 women per year for those who took both hormones and supplements. Women who took only hormones had a hip fracture rate of 18 per 10,000, while those who took only supplements had a hip fracture rate of 25 per 10,000. Women who received neither therapy had 22 hip fractures per 10,000 women.

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calcium and iron

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Understanding Calcium: Supplements, Calcium Carbonate, Calcium Citrate, and More

Experts share their advice about what to consider when choosing a calcium supplement.

Are you getting enough calcium in your diet? Maybe not, especially if you're a woman or a teenage girl. Although Americans have improved at this in recent years, we're still not getting enough calcium to maintain our bone health.

How much is that? It depends on your age. According to the Institute of Medicine, the recommended daily amount of calcium to get is:

1-3 years: 700 milligrams daily4-8 years: 1,000 milligrams daily9-18 years: 1,300 milligrams daily19-50 years: 1,000 milligrams daily51-70 years: 1,200 milligrams daily for women; 1,000 milligrams daily for men71 and older: 1,200 milligrams daily

The Institute of Medicine says that most in the U.S. get enough calcium, except for girls 9 to 18 years old. Although women’s recommended calcium needs to increase with menopause, postmenopausal woman taking supplements may also be at greater risk of getting too much calcium.

"We know that peak bone mass occurs around age 30, so it's very important in childhood and adolescence to have a healthy intake of calcium early on," says Marcy B. Bolster, MD. She is a professor of medicine in the division of rheumatology and immunology at the Medical University of South Carolina and director of the MUSC Center for Osteoporosis and Bone Health.

"After age 30, we start to gradually lose bone, and that loss accelerates for women at the time of menopause. So it's very important to stave off bone loss with adequate calcium intake."

Your health care provider may recommend calcium supplements. But with so many choices of calcium supplements, where should you start? Here's what you need to know.

"I tell my patients to take the kind that they tolerate best and is least expensive," Bolster says. She says she recommends calcium carbonate because "it's inexpensive, won't cause discomfort, and is a good source of calcium."

Some people's bodies may have problems making enough stomach acid, or may be taking medications that suppress acid production. For them, says J. Edward Puzas, MD, a calcium citrate supplement might be better because it "dissolves a little better than calcium carbonate for these people." Puzas is a professor of orthopedics and director of orthopedic research at the University of Rochester Medical Center in New York.

What about other types of supplements, like calcium plus magnesium, coral calcium, and so on? Not necessary, the experts tell WebMD. But they note that supplements that combine calcium with vitamin D -- which is essential for the body to appropriately absorb calcium -- provide an added benefit.

The body can absorb only about 500 milligrams of a calcium supplement at any one time, says Puzas, so you can't just down a 1000-mg supplement first thing in the morning and call it a day.

Instead, split your dose into two or three servings a day. "The best way to take it is with a meal; calcium is absorbed better that way," Puzas says. If your daily diet includes calcium-containing foods and drinks, you may not need multiple doses.

View the original article here

Calcium and Potassium falling short....

Hello All, 

I am trying to find things to balance all my little sections under the analysis section but I seem to be falling for in the Calcium and Potassium Sections. I know Calcium I can get through more dairy products which I plan on getting some fat free yogurts for that but I have no clue how to get my potassium up any higher without going over my daily calorie limits :/ I do already eat 2 medium bananas a day for potassium but it just doesn't seem to be enough. So any suggestions on these 2 areas would be great.... Thank You :D 

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Are calcium supplements unhealthy for men?

Posted May 16, 2013, 2:00 am

I’m a man in my 60s. I’ve been taking a calcium supplement to protect my bones, but I recently read that men shouldn’t take calcium supplements. Why not?

I wish I could give you a clear answer. Several recent studies have raised a question about whether regular use of calcium supplements might be bad for the heart. The bottom line: It’s too early to know if this risk is real.

There’s no doubt that we need calcium. It helps muscles to contract, blood to clot and nerves to communicate. And it plays an important role in building strong teeth and bones. As a result, many people take calcium supplements for bone health.

One new study followed the health of nearly 400,000 men and women. The study was published in the medical journal JAMA Internal Medicine. At the study’s start, the participants reported how much supplemental calcium they took. From diet surveys, the researchers estimated how much calcium the study participants were getting from food.

During 12 years of follow-up, men who took more than 1,000 milligrams (mg) of supplemental calcium per day were 20 percent more likely to succumb to heart disease than those who didn’t take calcium supplements. But there was no connection between calcium supplements and heart disease in women, and there was no connection with calcium from food.

Another recent study that followed more than 61,000 women in Sweden was published in the medical journal BMJ. Among women who took more than 1,400 milligrams per day of calcium supplements, the risk of premature death was more than doubled — particularly death from heart disease.

Both of these studies, and others that have pointed in a similar direction, involve large numbers of people and were carefully conducted. Yet they are observational studies, and you can’t make judgments about cause and effect from such studies. They clearly showed that men and women who took relatively high doses of calcium supplements had higher risks. But that doesn’t prove that the calcium supplements were the cause of higher rates of heart problems and death.

Surely, these studies don’t mean that you should forsake all calcium. Everyone needs calcium to keep bones strong, taken in conjunction with the bone-building vitamin, vitamin D. Losing calcium weakens bones and leaves them more prone to breaking. (I’ve put a table listing the daily recommended intakes of calcium and vitamin D below.)

With the safety of calcium supplements in question, try to get as much calcium as possible from food. Good calcium sources include:

Low-fat milk and cheese;Calcium-fortified orange juice or soy milk;Breakfast cereals (which are also fortified);Leafy greens, particularly, kale, turnip greens and Swiss chard. (Go easy on spinach. It is high in iron, which tends to block calcium absorption.)Sardines and other canned fish with bones included.

I’m sure there will be more research studies on this important question. I’ll keep you posted.

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Healthy Older Women Advised Against Taking Calcium

Title: Healthy Older Women Advised Against Taking Calcium
Category: Health News
Created: 2/25/2013 6:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM

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Healthy Older Women Advised Against Taking Calcium

By Barbara Bronson Gray

HealthDay Reporter

MONDAY, Feb. 25 (HealthDay News) -- Healthy older women should not take calcium and vitamin D supplements to prevent fractures, according to a final recommendation issued Monday by the U.S. Preventive Services Task Force.

In healthy adults, lower doses of calcium and vitamin D seem to be ineffective. As for higher doses, it's still up in the air, the government group said.

The new recommendations do not apply to people who are known to be vitamin D-deficient or who already have osteoporosis, the U.S. Preventive Services Task Force (USPSTF) noted.

Every year about 1.5 million fractures in the United States are attributed to osteoporosis, which is caused by a decrease in bone mass and density that makes bones fragile and more susceptible to a break. Almost half of all women older than 50 will have an osteoporosis-related fracture in their lifetime, according to the USPSTF.

Calcium is one of the main building blocks of bone growth, and vitamin D (sourced via sunlight's action on the skin, or through diet) helps bones absorb calcium. But at issue is whether people receive enough of these nutrients in their daily diet, or if supplements would help protect them.

Dr. Virginia Moyer, chair of the USPSTF, and a professor of pediatrics at Baylor College of Medicine, said experts know that a "medium dose" of supplements -- less than 400 international units (IU) of vitamin D and less than 1,000 milligrams (mg) of calcium -- does not work.

As for higher doses? "We simply don't know. There are reasons to think they could work, but unfortunately, even though there are a bunch of studies, there are problems with them," Moyer said.

"We know these recommendations will be very frustrating to both physicians and patients, but it's a call to action to the research community," she added.

The USPSTF analyzed a wide range of studies on the effects of supplementation of vitamin D and calcium levels for bone health and the adverse effects of supplementation. The report, published online Feb. 26 in the Annals of Internal Medicine, makes these points about preventing fractures:

Don't take low doses of daily supplements: Less than 400 IU of vitamin D and less than 1,000 mg of calcium after menopause have no benefit.For higher doses: The task force doesn't have sufficient evidence to make a recommendation on daily supplements.For men and women younger than 50: The task force also doesn't have enough evidence to make a recommendation on vitamin D and calcium supplements.

The report notes a downside to low-dose supplementation: Taking 400 IU or less of vitamin D and 1,000 mg or less of calcium increases the risk of kidney stones, which can be painful and may require hospitalization.

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Calcium Supplements May Raise Odds of Heart Death in Women

By Steven Reinberg

HealthDay Reporter

TUESDAY, Feb. 12 (HealthDay News) -- Women eating a high-calcium diet and taking calcium supplements adding up to more than 1,400 milligrams a day may be running nearly twice the risk of dying from heart disease, a large Swedish study suggests.

Both men and women take calcium supplements to prevent bone loss. The new findings come on the heels of another recent study that found a similar increased risk of death related to calcium intake among men.

"Many older adults increase dietary intake of calcium or take calcium supplements to prevent bone loss and there had been speculation that increased calcium intake with or without vitamin D could improve cardiovascular health," said Dr. Gregg Fonarow, an American Heart Association spokesman who wasn't involved in the study.

However, a number of recent studies have suggested that higher dietary intake or calcium supplementation may not only not improve cardiovascular health -- they may be associated with increased risk for cardiovascular events and mortality, said Fonarow, a professor of cardiology at University of California, Los Angeles.

The new report was published in the Feb. 12 online edition of the BMJ.

To see if calcium supplements raised the risk of dying from heart disease, a team led by Dr. Karl Michaelsson, a clinical professor in the department of orthopedic surgical sciences at Uppsala University in Sweden, analyzed data collected on more than 61,000 women enrolled in a study on mammograms.

Over 19 years of follow-up, nearly 12,000 women died -- almost 4,000 dying from cardiovascular disease, about 1,900 from heart disease and 1,100 from stroke, the researchers found.

The highest rates of death were seen among women whose calcium intake was higher than 1,400 milligrams a day, the researchers noted. On the other hand, women who took less than 600 milligrams of calcium a day were also at an increased risk of death.

Moreover, women taking 1,400 milligrams of calcium a day and also using a supplement had even a higher risk of dying than women not using supplements, Michaelsson's group found.

All in all, women getting more than 1,400 milligrams of calcium a day were more than twice as likely to die than women getting 600 to 999 milligrams a day, the researchers said.

The U.S. Office of Dietary Supplements recommends 1,000 to 1,200 milligrams of calcium a day for most adults.

According to the study authors, diets very low or very high in calcium can override normal control by the body, causing changes in blood levels of calcium.

Rather than worry about increasing calcium intake of those getting enough through their diet, emphasis should be placed on people with a low intake of calcium, the authors suggest.

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Calcium Supplements May Raise Men's Death Risk From Heart Disease

By Steven Reinberg

HealthDay Reporter

MONDAY, Feb. 4 (HealthDay News) -- Men taking calcium supplements may be running a nearly 20 percent increased risk of dying from cardiovascular disease, a new study suggests.

Both men and women take calcium supplements to prevent bone loss. In this study of calcium intake, the risk of dying from heart disease was higher for men but not for women.

"Increasing evidence indicates that too much supplemental calcium might increase the risk of cardiovascular disease," said Susanna Larsson, an associate professor at the Institute of Environmental Medicine at the Karolinska Institute, in Stockholm.

Larsson, who was not part of the study but wrote an accompanying journal editorial, added that "the paradigm 'the more the better' seems invalid for calcium supplementation."

The report was published in the Feb. 4 online edition of the journal JAMA Internal Medicine.

To find out if calcium supplements were associated with an increased risk of dying from cardiovascular disease, a team of scientists led by Qian Xiao, of the U.S. National Cancer Institute, collected data on more than 388,000 men and women, aged 50 to 71 years old. They took part in a study on diet and health conducted by the U.S. National Institutes of Health and the AARP from 1995 to 1996.

Over an average 12 years of follow-up, about 7,900 men died from cardiovascular disease, as did nearly 4,000 women. Among those who died, 51 percent of men and 70 percent of women were taking calcium supplements, the researchers found.

Xiao's group calculated that men taking 1,000 milligrams a day of a calcium supplement had a 20 percent increased risk of dying from heart disease. Men also had a 14 percent increased risk of dying from a stroke, but this was not statistically significant, the researchers said.

Among women, however, calcium supplements were not linked to an increased risk of dying from cardiovascular disease. And, calcium from diet didn't increase the risk of dying from cardiovascular disease for either sex, the researchers found.

The study authors said more research is needed to determine whether there is difference between men and women in the cardiovascular effects of calcium supplements.

"Given the extensive use of calcium supplements in the population[often for osteoporosis], it is of great importance to assess the effect of supplemental calcium use beyond bone health," the investigators concluded in the study.

Taylor Wallace, a representative of the supplement industry, faulted this and other studies because, he said, they were not specifically meant to address calcium supplements and heart disease.

Wallace, who is senior director for Scientific & Regulatory Affairs at the Council for Responsible Nutrition, said most studies of calcium supplements show no effects on the heart.

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